BACKGROUND & AIMS: :It is well reported in the epilepsy literature that use of antiepileptic drugs (AEDs) leads to bone loss. Validated instruments were administered to assess knowledge, health behavior, quality of life, and stigma, to determine their effects on self-efficacy for osteoprotective and self-management behaviors. This adult epilepsy population had a mean age of 45, with 20 years of AED exposure. Fifty subjects were Caucasian and 44 were non-Caucasian. By one-way ANOVA, there were significant differences in self-efficacy based on ethnicity, medical assistance, status, and seizure frequency. Differences in knowledge based on ethnicity, education, and income were also noted. Regression analysis revealed that the factors that most predict self-efficacy for calcium, exercise, and self-management do not parallel each other. Age and ethnicity were predictive of self-efficacy for epilepsy self-management only. Medical management factors varied among the models. Overall quality of life was a positive predictor for both calcium and exercise self-efficacy.

背景与目标： ：在癫痫文献中有充分的报道指出，使用抗癫痫药（AED）会导致骨质流失。使用经过验证的工具来评估知识，健康行为，生活质量和污名，以确定它们对自我保护对骨保护和自我管理行为的影响。该成人癫痫患者的平均年龄为45岁，暴露于AED的时间为20年。五十名受试者是高加索人，四十四名非高加索人。通过单因素方差分析，根据种族，医疗救助，身份和癫痫发作频率，自我效能有显着差异。还指出了基于种族，教育和收入的知识差异。回归分析显示，最能预测钙的自我效能，运动和自我管理的因素并不相互平行。年龄和种族仅能预测癫痫自我管理的自我效能。医疗管理因素因模型而异。总体生活质量是钙和运动自我效能的积极预测指标。

BACKGROUND & AIMS: These experiments were designed to determine whether glycogenolysis was influenced by the glycogen concentration of vascular smooth muscle. Segments of hog carotid artery smooth muscle were allowed to synthesize variable amounts of 1-[13C]glucosyl units of glycogen. Artery segments were then isometrically contracted in the presence of 2-[13C]glucose. Prior to and after isometric contraction, measurements were made of tissue glycogen content and superfusate glucose and lactate concentrations. 2-[13C]Lactate and 3-[13C]lactate peak intensities in the superfusate were measured using 13C-NMR spectroscopy. The tissue glycogen content decreased exponentially during the 4.5 h of isometric contraction (R2 = 0.990), despite more than a 3-fold range of glycogen concentration prior to contraction. The extent of glycogen utilization during a 3 h isometric contraction varied linearly with the precontraction glycogen concentration (R2 = 0.727). Lactate production specifically from glycogen breakdown increased with an increase in precontraction glycogen concentration (R2 = 0.620). During a 3 h isometric contraction neither the glucose utilization (R2 = 0.007) nor lactate production specifically produced from glucose (R2 = 0.00002) varied with the precontraction glycogen concentration. It is concluded that the rate of glycogenolysis is determined by the content of glycogen during prolonged contractions. In addition, precontraction glycogen levels influence the pathway for glycogen utilization but not the pathway for glucose utilization. Therefore, glycolysis and glycogenolysis behave independently in vascular smooth muscle.

背景与目标： 设计这些实验以确定糖原分解是否受血管平滑肌糖原浓度的影响。允许猪颈动脉平滑肌节段合成糖原的1- [13C]葡糖基单元。然后在2- [13C]葡萄糖存在下，等距收缩动脉段。在等距收缩之前和之后，测量组织糖原含量和超融合葡萄糖和乳酸浓度。使用13C-NMR光谱法测量超熔液中的2- [13C]乳酸盐和3- [13C]乳酸盐峰强度。尽管在收缩前糖原浓度的3倍范围内，组织糖原含量在等长收缩的4.5小时内呈指数下降（R2 = 0.990）。在3小时的等距收缩过程中，糖原利用的程度随收缩前糖原浓度的变化而线性变化（R2 = 0.727）。特别是糖原分解产生的乳酸根随收缩前糖原浓度的增加而增加（R2 = 0.620）。在3小时的等距收缩过程中，葡萄糖利用量（R2 = 0.007）或由葡萄糖专门产生的乳酸产量（R2 = 0.00002）都不会随收缩前糖原浓度的变化而变化。结论是糖原分解的速率取决于长时间收缩过程中糖原的含量。另外，收缩前糖原水平影响糖原利用的途径，但不影响葡萄糖利用的途径。因此，糖酵解和糖原分解作用在血管平滑肌中独立发生。

BACKGROUND & AIMS: :Health care workers' perceptions of patient suffering have not been well studied. Patients and health care workers were invited to answer a single, open-ended question. To develop a survey tool that could be validated and used for future research, what health care workers thought causes or caused the most suffering for patients was compared with what patients actually identified as the cause of their worst suffering. Health care workers underestimated loss and significantly underestimated physical nonpainful symptoms as causes of maximal suffering. Communication, emotional, and systems issues were often overestimated by health care workers. Health care workers may not accurately perceive what causes the worst suffering for patients. More studies are needed.

背景与目标： ：医护人员对患者痛苦的看法尚未得到很好的研究。邀请患者和医护人员回答一个开放性问题。为了开发一种可以验证并用于未来研究的调查工具，将医护人员认为造成或造成患者最大痛苦的原因与实际确定为造成其最严重痛苦的原因进行了比较。医护人员低估了损失，严重低估了身体无痛的症状，这是造成最大痛苦的原因。沟通，情感和系统问题经常被医护人员高估。医护人员可能无法准确地了解是什么导致患者遭受最严重的痛苦。需要更多的研究。

BACKGROUND & AIMS: BACKGROUND:Somatizing patients have maladaptive and increased rates of medical care utilization. If there were a way of routinely identifying such patients, one that did not require intensive, case-by-case review, they could be targeted for specific interventions to improve their use of medical care. OBJECTIVE:We sought to identify patterns of medical care utilization that would distinguish somatizing and nonsomatizing medical outpatients with acceptable sensitivity and specificity. DESIGN:Subjects completed questionnaires assessing somatization and sociodemographic characteristics. Their medical care utilization was obtained for the 12 months preceding the index visit. We then used multivariable logistic regression and recursive partitioning to identify patients with a provisional diagnosis of somatoform disorder. These exploratory models used various patterns of medical care utilization and sociodemographic characteristics as the independent variables. SUBJECTS:We studied consecutive adults attending 2 primary care practices on randomly chosen days. MEASURES:The provisional diagnosis of a somatoform disorder was assessed with a 15-item self-report questionnaire. The number of primary care visits, specialty visits, mental health visits, emergency visits, and inpatient and outpatient costs were obtained for the 12 months preceding the index visit from our hospital's automated medical records, which also provided a rating of aggregate medical morbidity. Self-reported utilization outside our hospital system was obtained from a subsample of patients. RESULTS:Complete data were obtained on 1440 patients. Somatizing patients had more specialty care than primary care visits, higher outpatient than inpatient costs, and more emergency visits than nonsomatizing patients. A regression model containing 7 measures of utilization and 4 sociodemographic characteristics distinguished somatizing and nonsomatizing patients with a c-statistic = 0.73. Recursive partitioning identified 10 terminal nodes with a very high specificity (99%) but a very low sensitivity (15%). CONCLUSIONS:We identified 7 discrete patterns of medical care utilization that distinguished somatizing and nonsomatizing patients. However, they did so with only modest specificity and sensitivity. This algorithm might be used effectively as the first step in a 2-step screening procedure whose second step would entail more intensive screening or individual, case-by-case review to identify somatizing patients in primary care practice.

背景与目标： 背景：躯体化患者适应不良，医疗利用率更高。如果有一种常规识别此类患者的方法，而无需进行深入的个案审查，则可以针对他们采取特定的干预措施，以改善他们对医疗的使用。
目的：我们试图确定可以利用可接受的敏感性和特异性来区分躯体化和非躯体化门诊患者的医疗利用模式。
设计：受试者完成问卷调查，评估躯体化和社会人口统计学特征。在索引访问之前的12个月中获得了他们的医疗保健利用率。然后，我们使用多变量logistic回归和递归分区来确定患有躯体形式疾病的临时诊断的患者。这些探索性模型使用了各种医疗保健利用模式和社会人口统计学特征作为自变量。
受试者：我们研究了在随机选择的日子里连续参加2种初级保健实践的成年人。
措施：用15个项目的自我报告调查表对躯体形式障碍的临时诊断进行了评估。在索引访问之前的12个月中，从我们医院的自动医疗记录中获得了初级保健就诊，专科就诊，心理健康就诊，急诊就诊以及住院和门诊费用的数量，还提供了总的发病率。我们从患者子样本中获得了我们医院系统外部的自我报告利用率。
结果：获得了1440例患者的完整数据。躯体化患者比初级保健就诊者拥有更多的专科护理，门诊患者比住院费用更高，并且急诊就诊者比非躯体化患者更多。包含7个使用率度量标准和4个社会人口统计学特征的回归模型以c统计量= 0.73区分了躯体化和非躯体化的患者。递归分区确定了10个终端节点，它们的特异性很高（99％），但敏感性很低（15％）。
结论：我们确定了7种离散的医疗服务利用模式，分别区分了躯体化和非躯体化的患者。但是，他们这样做只是出于适度的特异性和敏感性。该算法可以有效地用作两步筛查程序中的第一步，该步骤的第二步将需要进行更深入的筛查，或者进行逐项个案审查，以识别初级保健实践中的躯体化患者。

BACKGROUND & AIMS: OBJECTIVE:This study reviewed whether participants who were given a continence education package, which included a Continence Educational Brochure (CEB), and who indicated that they were bothered by incontinence symptoms changed health-seeking behaviors about their incontinence problem because of being given the brochure. METHOD:This study used a descriptive and exploratory design. Participants were given the CEB and asked to read the information. They were also asked to complete a continence questionnaire and mail this back to the research team. Participants who indicated that they were bothered by a continence problem and consented to being interviewed were telephoned 2 to 3 months later. They were asked questions to determine their actions and progress in relation to managing their continence problem and whether the CEB had influenced their behavior. SETTING AND SUBJECT:A total of 631 participants (352 females, 55.8%; 279 males, 44.2%) from 4 rural and regional settings in Victoria, Australia, participated. Of this sample, 111 participants (78 females, 70.3%; 33 males, 29.7%) who reported that they were bothered by a continence problem were interviewed 3 months after being given the CEB. RESULTS:Two thirds of the total sample of participants (n=111) sought help for their continence problem. Approximately 70.3% (n=78) continued to have a continence problem. Of this group, 84.6% were still bothered by the continence problem and 65.4% had taken action to treat their incontinence. Forty-nine participants (44.1%) indicated that they had discussed the issue of bladder or bowel problems with someone directly because of this study or the information contained in the brochure. More than 94% of participants who remembered the CEB indicated that they believed the brochure would be helpful if given to other people. CONCLUSIONS:These findings suggest that the CEB prompted individuals to discuss their continence problem and in fewer cases to seek professional help. Given these findings, distribution of a continence education package is advocated as a continence health promotion strategy.

背景与目标： 目的：本研究回顾了参加者的节制教育包，其中包括节制教育手册（CEB），并指出他们因节制失禁症状而受到困扰，从而改变了他们对失禁问题的健康寻求行为，因为他们获得了手册。
方法：本研究采用描述性和探索性设计。参加者获得了CEB的邀请，并要求阅读信息。还要求他们填写节制问卷并将其邮寄回研究团队。 2至3个月后打电话给表示自己受到节制问题困扰并同意接受采访的参与者。他们被问到问题，以确定他们在处理自控问题方面的行动和进展，以及CEB是否影响了他们的行为。
地点和主题：来自澳大利亚维多利亚州4个农村和地区性地区的631名参与者（352名女性，占55.8％； 279名男性，占44.2％）参加了该项目。在该样本中，有111名参与者报告他们受到节制问题困扰，其中有78名女性，占70.3％； 33名男性，占29.7％，在接受CEB后三个月进行了访谈。
结果：参与者（n = 111）的总样本的三分之二寻求帮助，以解决他们的节制问题。大约70.3％（n = 78）仍然存在尿失禁问题。在这一组中，仍有84.6％的人患有尿失禁问题，还有65.4％的人已经采取了行动来治疗他们的尿失禁。 49名参与者（44.1％）表示，由于该研究或小册子中包含的信息，他们直接与某人讨论了膀胱或肠道问题。记得CEB的参与者中，超过94％的参与者表示，他们认为该手册对其他人有帮助。
结论：这些发现表明，CEB促使个人讨论他们的节制问题，并在较少的情况下寻求专业帮助。鉴于这些发现，提倡分发节制教育一揽子计划作为节制健康促进策略。

BACKGROUND & AIMS: :This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.

背景与目标： ：这项研究旨在阐明消化道手术后口腔护理的有效性，包括刷牙，义齿清洁和舌头清洁。受试者包括接受消化道手术的30位年龄在60-98岁（74.9 /-7.8岁）的老年患者。将受试者随机分为干预组和对照组。在干预组中，每天从基线（手术日）开始，在每天的5分钟内，每天进行以下口腔护理，并持续5天：用聚维酮碘漱口，刷牙，使用专用刷子清洁义齿和使用舌刷清洁舌头。在对照组中，受试者仅含聚维酮碘。我们在基线和5天后比较了两组之间的以下变量：口干的感觉，口内气体浓度，肺音，体温和细菌菌群。在干预组中，肺音异常（干音或湿音）的患者数量从1增加到2，在对照组中从0增加到4（P <0.05）。对照组术前平均细菌种类为3.64 /-1.34，术后为3.50 /-1.74，而干预组术前为3.08 /-0.95，术后为2.62 /-0.65。操作上。在干预组中，细菌种类的数量显着减少（P <0.05）。这些发现表明，接受消化道手术的老年患者的术后口腔护理降低了在口腔中发现的细菌种类的数量。反过来，这种效果可能会改善呼吸功能。

BACKGROUND & AIMS: BACKGROUND:Although the benefit of thrombolytic therapy in reducing mortality in acute myocardial infarction is well established, the types of bleeding and risk factors for bleeding are less well described in large trials.

METHODS AND RESULTS:We analyzed the baseline characteristics, outcomes, and incidence of bleeding by location, severity, and treatment assignment among 41,021 patients in the GUSTO-I trial of thrombolysis for acute myocardial infarction. Of the 40,903 patients for whom there were complete data, 1.2% suffered severe bleeding and 11.4% experienced moderate hemorrhage at a variety of sites. The most common sources of bleeding were procedure related. The thrombolytic regimen was strongly related to the incidence of bleeding; comparatively more bleeding was seen with the therapies of streptokinase plus intravenous heparin and the streptokinase and tissue plasminogen activator plus intravenous heparin combination. In multivariate analysis, the four most powerful independent predictors of hemorrhage were older age, lighter body weight, female sex, and African ancestry; they remained the most important predictors of bleeding when multivariate analysis was performed on patients who did not undergo invasive procedures. The presence of serious hemorrhage was associated with other undesirable outcomes (recurrent events, left ventricular dysfunction, arrhythmia, or stroke).

CONCLUSIONS:Important predictors of bleeding in this population are increased age, lighter weight, female sex, African ancestry, and experiencing invasive procedures. Other nonhemorrhagic adverse clinical outcomes were associated with moderate and severe bleeding, which was in turn associated with increased length of hospital stay and mortality at 30 days.

背景与目标： 背景：尽管溶​​栓治疗在降低急性心肌梗死死亡率方面的益处已得到广泛认可，但在大型试验中对出血的类型和出血的危险因素的描述却较少。

< strong>方法和结果：我们在GUSTO-I急性心肌梗塞试验的GUSTO-I试验中，对41,021例患者的基线特征，结局和出血发生率进行了分析，包括其位置，严重程度和治疗方案。在有完整数据的40,903名患者中，有1.2％出现严重出血，11.4％的患者在不同部位出现中度出血。最常见的出血来源与手术有关。溶栓方案与出血发生率密切相关。链激酶加静脉肝素，链激酶和组织纤溶酶原激活剂加肝素联合治疗的出血量相对较多。在多变量分析中，出血的四个最有力的独立预测因子是年龄大，体重轻，女性和非洲血统。当对未进行侵入性治疗的患者进行多变量分析时，它们仍然是出血的最重要预测指标。严重出血的存在与其他不良后果（复发事件，左心室功能障碍，心律不齐或中风）相关。

结论：该人群出血的重要预测因素是年龄增加，体重减轻，女性性别，非洲血统和经历侵入性程序。其他非出血性不良临床预后与中度和重度出血有关，这又与住院天数的延长和30天病死率有关。